I 

118TH CONGRESS 

2D SESSION H. R. 9232 

To amend title XVIII of the Social Security Act to establish coverage for 

certain residential substance use disorder services under the Medicare 

program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 30, 2024 

Ms. UNDERWOOD (for herself, Mr. TONKO, Mr. VALADAO, and Mrs. MILLER

of West Virginia) introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to establish 

coverage for certain residential substance use disorder 

services under the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Residential Recovery 

5 for Seniors Act’’. 


ssavage on LAPJG3WLY3PROD with BILLS
2 

•HR 9232 IH

1 SEC. 2. ESTABLISHING COVERAGE FOR CERTAIN RESIDEN2 TIAL SUBSTANCE USE DISORDER SERVICES 

3 UNDER THE MEDICARE PROGRAM. 

4 (a) COVERAGE UNDER PART A.—Section 1812(a) of 

5 the Social Security Act (42 U.S.C. 1395d(a)) is amend6 ed— 

7 (1) in the header, by striking ‘‘AND’’ and insert8 ing ‘‘, AND RESIDENTIAL SUBSTANCE USE DIS9 ORDER SERVICES’’ after ‘‘HOSPICE CARE’’; 

10 (2) in paragraph (4), by striking ‘‘and’’ at the 

11 end; 

12 (3) in paragraph (5), by striking the period at 

13 the end and inserting ‘‘;’’; and 

14 (4) by adding at the end the following new 

15 paragraphs: 

16 ‘‘(6) clinically managed low-intensity residential 

17 substance use disorder services (as defined in section 

18 1861(nnn)(1)) furnished to an individual who is a 

19 resident of a clinically managed residential substance 

20 use disorder facility (as defined in section 

21 1861(nnn)(3)) if the individual’s initial need for 

22 such level of services is performed, and continued 

23 need for such level of services is reviewed and re24 affirmed periodically (on a frequency specified by the 

25 Secretary that is not less often than every 30 days), 

26 in accordance with the most current edition apVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
3 

•HR 9232 IH

1 proved by the Secretary of evidence-based, substance 

2 use disorder-specific criteria developed by a non3 profit medical association generally recognized for its 

4 expertise in addiction treatment; 

5 ‘‘(7) clinically managed high-intensity residen6 tial substance use disorder services (as defined in 

7 section 1861(ooo)(1)) furnished to an individual who 

8 is a resident of a clinically managed residential sub9 stance use disorder facility (as defined in section 

10 1861(nnn)(3)) if the individual’s initial need for 

11 such level of services is performed, and continued 

12 need for such level of services is reviewed and re13 affirmed periodically (on a frequency specified by the 

14 Secretary that is not less often than every 30 days), 

15 in accordance with the most current edition ap16 proved by the Secretary of evidence-based, substance 

17 use disorder-specific criteria developed by a non18 profit medical association generally recognized for its 

19 expertise in addiction treatment; and 

20 ‘‘(8) medically managed residential substance 

21 use disorder services (as defined in section 

22 1861(ppp)(1)) furnished to an individual who is a 

23 resident of a medically managed residential sub24 stance use disorder facility (as defined in section 

25 1861(ppp)(3)) if the individual’s initial need for 


ssavage on LAPJG3WLY3PROD with BILLS
4 

•HR 9232 IH

1 such level of services is performed, and continued 

2 need for such level of services is reviewed and re3 affirmed periodically (on a frequency specified by the 

4 Secretary that is not less often than every 10 days), 

5 in accordance with the most current edition ap6 proved by the Secretary of evidence-based, substance 

7 use disorder-specific criteria developed by a non8 profit medical association generally recognized for its 

9 expertise in addiction treatment.’’. 

10 (b) RESIDENTIAL SUBSTANCE USE DISORDER SERV11 ICES, PROGRAMS, AND FACILITIES DEFINED.—Section 

12 1861 of the Social Security Act (42 U.S.C. 1395x) is 

13 amended by adding at the end the following new sub14 sections: 

15 ‘‘(nnn) CLINICALLY MANAGED LOW-INTENSITY RES16 IDENTIAL SUBSTANCE USE DISORDER SERVICES, PRO17 GRAM, AND FACILITY.— 

18 ‘‘(1) CLINICALLY MANAGED LOW-INTENSITY

19 RESIDENTIAL SUBSTANCE USE DISORDER SERV20 ICES.—The term ‘clinically managed low-intensity 

21 residential substance use disorder services’ means 

22 the following items and services furnished to an indi23 vidual in a clinically managed low-intensity residen24 tial substance use disorder program (as defined in 

25 paragraph (2)) and (except as provided in subparaVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
5 

•HR 9232 IH

1 graph (C)) by such program for the treatment of 

2 substance use disorders and co-occurring conditions, 

3 including— 

4 ‘‘(A) bed and board; 

5 ‘‘(B) such clinical services and other re6 lated services (including substance use disorder 

7 and co-occurring condition assessments and 

8 treatment planning), such use of clinically man9 aged residential substance use disorder facili10 ties, and such medical social services (including 

11 recovery support services), as are ordinarily fur12 nished by the clinically managed low-intensity 

13 residential substance use disorder program for 

14 the care and treatment of individuals in such 

15 program, and such drugs, supplies, appliances, 

16 and equipment, for use in the clinically man17 aged low-intensity residential substance use dis18 order program, as are ordinarily furnished by 

19 such program for the care and treatment of in20 dividuals in such program; and 

21 ‘‘(C) such other diagnostic or therapeutic 

22 items or services, furnished by the clinically 

23 managed low-intensity residential substance use 

24 disorder program or by others under arrange25 ments with them made by the clinically manVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
6 

•HR 9232 IH

1 aged low-intensity residential substance use dis2 order program, as are ordinarily furnished to 

3 individuals either by such clinically managed 

4 low-intensity residential substance use disorder 

5 program or by others under such arrangements, 

6 excluding— 

7 ‘‘(i) medical or surgical services pro8 vided by a physician, services described by 

9 subsection (s)(2)(K), and qualified psychol10 ogist services; and 

11 ‘‘(ii) the services of a private-duty 

12 nurse or other private-duty attendant. 

13 ‘‘(2) CLINICALLY MANAGED LOW-INTENSITY

14 RESIDENTIAL SUBSTANCE USE DISORDER PRO15 GRAM.—The term ‘clinically managed low-intensity 

16 residential substance use disorder program’ means a 

17 residential program which— 

18 ‘‘(A) is primarily engaged in providing 24- 

19 hour structure and support and integrated clin20 ical services for the diagnosis, treatment, and 

21 care of individuals with substance use disorders 

22 who need structure and support to build and 

23 practice their recovery and coping skills; 

24 ‘‘(B) directly provides a substance use dis25 order-specific multidimensional level of care asVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
7 

•HR 9232 IH

1 sessment at admission to determine the rec2 ommended level of care, using protocols devel3 oped by a physician or advanced practice pro4 vider with experience in specialty addiction 

5 treatment to confirm the appropriateness of 

6 treatment in such program for individuals who 

7 are intoxicated, experiencing withdrawal, or pre8 senting with biomedical comorbidities; 

9 ‘‘(C) directly provides, or has a direct af10 filiation with, a provider or providers who can 

11 provide physical examinations, prescribe all ad12 diction and psychiatric medications, and provide 

13 medication management and laboratory testing 

14 as needed (except that access to methadone is 

15 not required if no providers of methadone for 

16 opioid use disorder are available, as determined 

17 by the Secretary); 

18 ‘‘(D) directly provides weekly clinical serv19 ices, in hourly increments to be determined by 

20 the Secretary, in an amount, frequency, and in21 tensity appropriate to an individual’s needs as 

22 determined by a substance use disorder-specific 

23 multidimensional assessment, with structured 

24 services available seven days per week; 


ssavage on LAPJG3WLY3PROD with BILLS
8 

•HR 9232 IH

1 ‘‘(E) maintains clinical records on all pa2 tients and maintains such records as the Sec3 retary finds to be necessary to determine the 

4 degree and intensity of the treatment provided 

5 to individuals entitled to clinically managed low6 intensity residential substance use disorder pro7 gram insurance benefits under part A, provided 

8 that the Secretary shall not require a program 

9 to maintain such records in a manner that is 

10 more extensive, detailed, or stringent than what 

11 is required of an institution that is considered 

12 a ‘hospital’ under subsection (e); 

13 ‘‘(F) coordinates patient referrals and 

14 transitions to other levels of care when needed, 

15 including transition planning in partnership 

16 with other providers participating in the Medi17 care program; and 

18 ‘‘(G) meets such additional staffing re19 quirements and other conditions as the Sec20 retary shall specify to ensure the effective and 

21 efficient furnishing of such program’s services 

22 and the compliance of such program with clini23 cally managed low-intensity residential sub24 stance use disorder program standards de25 scribed in the most current edition approved by 


ssavage on LAPJG3WLY3PROD with BILLS
9 

•HR 9232 IH

1 the Secretary of evidence-based, substance use 

2 disorder-specific criteria developed by a non3 profit medical association generally recognized 

4 for its expertise in addiction treatment. 

5 Obtaining and maintaining certification from a certi6 fying body that has the necessary competencies to 

7 assess compliance with such program standards and 

8 is approved by the Secretary shall be deemed to 

9 demonstrate compliance with the standards de10 scribed in subparagraph (G). 

11 ‘‘(3) CLINICALLY MANAGED RESIDENTIAL SUB12 STANCE USE DISORDER FACILITY.—The term ‘clini13 cally managed residential substance use disorder 

14 treatment facility’ means a facility which— 

15 ‘‘(A) is enrolled under section 1866(j); 

16 ‘‘(B) is accredited by an accrediting body 

17 approved by the Secretary; 

18 ‘‘(C) is legally authorized to provide a 

19 clinically managed low- or high-intensity resi20 dential substance use disorder program under 

21 the law of the State (or under a State regu22 latory mechanism provided by State law) in 

23 which the facility is located; and 

24 ‘‘(D) meets such additional conditions as 

25 the Secretary finds necessary in the interest of 


ssavage on LAPJG3WLY3PROD with BILLS
10 

•HR 9232 IH

1 the health and safety of individuals who are 

2 residents of such facilities and are furnished 

3 clinically managed low-intensity residential sub4 stance use disorder services (or clinically man5 aged high-intensity residential substance use 

6 disorder services, as the case may be). 

7 ‘‘(ooo) CLINICALLY MANAGED HIGH-INTENSITY

8 RESIDENTIAL SUBSTANCE USE DISORDER SERVICES AND

9 PROGRAM.— 

10 ‘‘(1) CLINICALLY MANAGED HIGH-INTENSITY

11 RESIDENTIAL SUBSTANCE USE DISORDER SERV12 ICES.—The term ‘clinically managed high-intensity 

13 residential substance use disorder services’ means 

14 the following items and services furnished to an indi15 vidual in a clinically managed high-intensity residen16 tial substance use disorder program (as defined in 

17 paragraph (2)) and (except as provided in subpara18 graph (C)) by such program for the treatment of 

19 substance use disorders and co-occurring conditions, 

20 including— 

21 ‘‘(A) bed and board; 

22 ‘‘(B) such clinical services and other re23 lated services (including substance use disorder 

24 and co-occurring condition assessments and 

25 treatment planning), such use of clinically manVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
11 

•HR 9232 IH

1 aged residential substance use disorder facili2 ties, and such medical social services (including 

3 recovery support services), as are ordinarily fur4 nished by the clinically managed high-intensity 

5 residential substance use disorder program for 

6 the care and treatment of individuals in such 

7 program, and such drugs, supplies, appliances, 

8 and equipment, for use in the clinically man9 aged high-intensity residential substance use 

10 disorder program, as are ordinarily furnished 

11 by such program for the care and treatment of 

12 individuals in such program; 

13 ‘‘(C) such other diagnostic or therapeutic 

14 items or services, furnished by the clinically 

15 managed high-intensity residential substance 

16 use disorder program or by others under ar17 rangements with them made by the clinically 

18 managed high-intensity residential substance 

19 use disorder program, as are ordinarily fur20 nished to individuals either by such clinically 

21 managed high-intensity residential substance 

22 use disorder program or by others under such 

23 arrangements, excluding— 

24 ‘‘(i) medical or surgical services pro25 vided by a physician, services described by 


ssavage on LAPJG3WLY3PROD with BILLS
12 

•HR 9232 IH

1 subsection (s)(2)(K), and qualified psychol2 ogist services; and 

3 ‘‘(ii) the services of a private-duty 

4 nurse or other private-duty attendant. 

5 ‘‘(2) CLINICALLY MANAGED HIGH-INTENSITY

6 RESIDENTIAL SUBSTANCE USE DISORDER PRO7 GRAM.—The term ‘clinically managed high-intensity 

8 residential substance use disorder program’ means a 

9 residential program which— 

10 ‘‘(A) is primarily engaged in providing 24- 

11 hour supervision for the diagnosis, treatment, 

12 and care of individuals with substance use dis13 orders who need a safe and stable living envi14 ronment to develop sufficient recovery skills so 

15 that they do not immediately relapse or con16 tinue to use in an imminently dangerous man17 ner upon transition to a less intensive level of 

18 care; 

19 ‘‘(B) directly provides a substance use dis20 order-specific multidimensional level of care as21 sessment at admission to determine the rec22 ommended level of care, using protocols devel23 oped by a physician or advanced practice pro24 vider experienced in specialty addiction treat25 ment to confirm the appropriateness of treatVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
13 

•HR 9232 IH

1 ment in such facility for individuals who are in2 toxicated, experiencing withdrawal, or pre3 senting with biomedical comorbidities; 

4 ‘‘(C) directly provides, or has a direct af5 filiation with, a provider or providers who can 

6 provide physical examinations, prescribe all ad7 diction and psychiatric medications, and provide 

8 medication management and laboratory testing 

9 as needed (except that access to methadone is 

10 not required if no providers of methadone for 

11 opioid use disorder are available, as determined 

12 by the Secretary); 

13 ‘‘(D) directly provides 20 hours or more of 

14 clinical services per week in an amount, fre15 quency, and intensity appropriate to individual 

16 patient needs as determined by a substance use 

17 disorder-specific multidimensional assessment, 

18 with structured services available seven days 

19 per week; 

20 ‘‘(E) directly provides clinically managed 

21 residential withdrawal management, including 

22 24-hour supervision, observation, and support 

23 for individuals who are intoxicated or experi24 encing withdrawal, who do not need medically 


ssavage on LAPJG3WLY3PROD with BILLS
14 

•HR 9232 IH

1 monitored or managed care (as determined 

2 through a medical evaluation); 

3 ‘‘(F) maintains clinical records on all pa4 tients and maintains such records as the Sec5 retary finds to be necessary to determine the 

6 degree and intensity of the treatment provided 

7 to individuals entitled to clinically managed 

8 high-intensity residential substance use disorder 

9 program insurance benefits under part A, pro10 vided that the Secretary shall not require a pro11 gram to maintain such records in a manner 

12 that is more extensive, detailed, or stringent 

13 than what is required of an institution that is 

14 considered a ‘hospital’ under subsection (e); 

15 ‘‘(G) management of patient referrals and 

16 transitions to other levels of care when needed; 

17 and 

18 ‘‘(H) meets such additional staffing re19 quirements and other conditions as the Sec20 retary shall specify to ensure the effective and 

21 efficient furnishing of such program’s services 

22 and the compliance of such program with clini23 cally managed high-intensity residential sub24 stance use disorder program standards de25 scribed in the most current edition approved by 


ssavage on LAPJG3WLY3PROD with BILLS
15 

•HR 9232 IH

1 the Secretary of evidence-based, substance use 

2 disorder-specific criteria developed by a non3 profit medical association generally recognized 

4 for its expertise in addiction treatment. 

5 Obtaining and maintaining certification from a certi6 fying body that has the necessary competencies to 

7 assess compliance with such program standards and 

8 is approved by the Secretary shall be deemed to 

9 demonstrate compliance with the standards de10 scribed in subparagraph (H). 

11 ‘‘(ppp) MEDICALLY MANAGED RESIDENTIAL SUB12 STANCE USE DISORDER SERVICES, PROGRAM, AND FA13 CILITY.— 

14 ‘‘(1) MEDICALLY MANAGED RESIDENTIAL SUB15 STANCE USE DISORDER SERVICES.—The term ‘medi16 cally managed residential substance use disorder 

17 services’ means the following items and services fur18 nished to an individual in a medically managed resi19 dential substance use disorder program (as defined 

20 in paragraph (2)) and (except as provided in sub21 paragraph (C)) by such program for the treatment 

22 of substance use disorders and co-occurring condi23 tions, including— 

24 ‘‘(A) bed and board; 

25 ‘‘(B) 24-hour nursing services; 


ssavage on LAPJG3WLY3PROD with BILLS
16 

•HR 9232 IH

1 ‘‘(C) such clinical services and other re2 lated services (including substance use disorder 

3 and co-occurring condition assessments and 

4 treatment planning), such use of medically 

5 managed residential substance use disorder fa6 cilities, and such medical social services (includ7 ing recovery support services), as are ordinarily 

8 furnished by the medically managed residential 

9 substance use disorder program for the care 

10 and treatment of residents of such program, 

11 and such drugs, supplies, appliances, and equip12 ment, for use in the medically managed residen13 tial substance use disorder program, as are or14 dinarily furnished by such program for the care 

15 and treatment of residents of such program; 

16 ‘‘(D) such other diagnostic or therapeutic 

17 items or services, furnished by the medically 

18 managed residential substance use disorder pro19 gram or by others under arrangements with 

20 them made by the medically managed residen21 tial substance use disorder program, as are or22 dinarily furnished to residents either by the 

23 medically managed residential substance use 

24 disorder program or by others under such ar25 rangements, excluding— 


ssavage on LAPJG3WLY3PROD with BILLS
17 

•HR 9232 IH

1 ‘‘(i) medical or surgical services pro2 vided by a physician, services described by 

3 subsection (s)(2)(K), and qualified psychol4 ogist services; and 

5 ‘‘(ii) the services of a private-duty 

6 nurse or other private-duty attendant. 

7 ‘‘(2) MEDICALLY MANAGED RESIDENTIAL SUB8 STANCE USE DISORDER PROGRAM.—The term ‘medi9 cally managed residential substance use disorder 

10 program’ means a residential program which— 

11 ‘‘(A) is primarily engaged in providing 

12 management of substance withdrawal and bio13 medical comorbidities, including diagnosis, 

14 treatment, and care, for individuals with sub15 stance use disorders who need 24-hour observa16 tion, monitoring, and treatment, but do not re17 quire the full resources of a hospital; 

18 ‘‘(B) directly provides a comprehensive 

19 nursing assessment at the time of admission, 

20 with a substance use disorder-focused history 

21 obtained as part of the initial assessment which 

22 is reviewed by a physician or advanced practice 

23 provider within 24 hours of admission; 

24 ‘‘(C) directly provides a comprehensive 

25 physical examination by a physician or adVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
18 

•HR 9232 IH

1 vanced practice provider within 24 hours of ad2 mission; 

3 ‘‘(D) directly provides sufficient biopsycho4 social screening and assessments of the pa5 tient’s substance use disorders and co-occurring 

6 disorders to determine the appropriate rec7 ommended level of care and treatment planning; 

8 ‘‘(E) directly provides daily medical inter9 ventions, including nursing and medical moni10 toring for stabilization of acute withdrawal, bio11 medical and psychiatric conditions, and psycho12 social services to encourage engagement in on13 going treatment, all in an amount, frequency, 

14 and intensity appropriate to individual patient 

15 needs as determined by a substance use dis16 order-specific multidimensional assessment; 

17 ‘‘(F) directly provides essential medications 

18 on site with policies and procedures that define 

19 essential medicines based on current standards 

20 of clinical practice and that ensure these medi21 cations are stocked and access to all Food and 

22 Drug Administration-approved medications for 

23 the treatment of substance use disorders (ex24 cept that access to methadone is not required if 

25 no providers of methadone for opioid use disVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
19 

•HR 9232 IH

1 order are available, as determined by the Sec2 retary); 

3 ‘‘(G) directly provides residential intoxica4 tion and withdrawal management services and 

5 residential management of biomedical condi6 tions; 

7 ‘‘(H) maintains clinical records on all pa8 tients and maintains such records as the Sec9 retary finds to be necessary to determine the 

10 degree and intensity of the treatment provided 

11 to individuals entitled to clinically managed 

12 high-intensity residential substance use disorder 

13 program insurance benefits under part A, pro14 vided that the Secretary shall not require a pro15 gram to maintain such records in a manner 

16 that is more extensive, detailed, or stringent 

17 than what is required of an institution that is 

18 considered a ‘hospital’ under subsection (e); 

19 ‘‘(I) management of patient transitions to 

20 other levels of care when needed; and 

21 ‘‘(J) meets such additional staffing re22 quirements and other conditions as the Sec23 retary shall specify to ensure the effective and 

24 efficient furnishing of such program’s services 

25 and the compliance of such program with cliniVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
20 

•HR 9232 IH

1 cally managed high-intensity residential sub2 stance use disorder program standards de3 scribed in the most current edition approved by 

4 the Secretary of evidence-based, substance use 

5 disorder-specific criteria developed by a non6 profit medical association generally recognized 

7 for its expertise in addiction treatment. 

8 Obtaining and maintaining certification from a certi9 fying body that has the necessary competencies to 

10 assess compliance with such program standards and 

11 is approved by the Secretary shall be deemed to 

12 demonstrate compliance with the standards de13 scribed in subparagraph (J). 

14 ‘‘(3) MEDICALLY MANAGED RESIDENTIAL SUB15 STANCE USE DISORDER FACILITY.—The term ‘medi16 cally managed residential substance use disorder 

17 treatment facility’ means a facility which— 

18 ‘‘(A) is enrolled under section 1866(j); 

19 ‘‘(B) is accredited by an accrediting body 

20 approved by the Secretary; 

21 ‘‘(C) is legally authorized to provide a 

22 medically managed residential substance use 

23 disorder program under the law of the State (or 

24 under a State regulatory mechanism provided 


ssavage on LAPJG3WLY3PROD with BILLS
21 

•HR 9232 IH

1 by State law) in which the facility is located; 

2 and 

3 ‘‘(D) meets such additional conditions as 

4 the Secretary finds necessary in the interest of 

5 the health and safety of individuals who are 

6 residents of such facilities and are furnished 

7 medically managed residential substance use 

8 disorder services.’’. 

9 (c) INCLUDING RESIDENTIAL SUBSTANCE USE DIS10 ORDER FACILITIES AS MEDICARE PROVIDERS.—Section 

11 1866(e) of the Social Security Act (42 U.S.C. 1395cc(e)) 

12 is amended— 

13 (1) in paragraph (2), by striking at the end 

14 ‘‘and’’; 

15 (2) in paragraph (3), by striking the period at 

16 the end and inserting ‘‘;’’; and 

17 (3) by adding at the end the following new 

18 paragraphs: 

19 ‘‘(4) clinically managed residential substance 

20 use disorder facilities (as defined in paragraph (3) 

21 of section 1861(nnn)), but only with respect to the 

22 furnishing of clinically managed low-intensity resi23 dential substance use disorder services (as defined in 

24 paragraph (1) of such section) and clinically man25 aged high-intensity residential substance use disVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
22 

•HR 9232 IH

1 order services (as defined in paragraph (1) of section 

2 1861(ooo)), as applicable; and 

3 ‘‘(5) medically managed residential substance 

4 use disorder facilities (as defined in paragraph (3) 

5 of section 1861(ppp)), but only with respect to the 

6 furnishing of clinically managed low-intensity resi7 dential substance use disorder services (as defined in 

8 paragraph (1) of section 1861(nnn)), clinically man9 aged high-intensity residential substance use dis10 order services (as defined in paragraph (1) of section 

11 1861(ooo)), and medically managed residential sub12 stance use disorder services (as defined in paragraph 

13 (1) of section 1861(ppp)), as applicable.’’. 

14 (d) PROSPECTIVE PAYMENT SYSTEM FOR RESIDEN15 TIAL SUBSTANCE USE DISORDER SERVICES.—Section 

16 1886 of the Social Security Act (42 U.S.C. 1395ww) is 

17 amended by adding at the end the following new sub18 section: 

19 ‘‘(u) PROSPECTIVE PAYMENT FOR RESIDENTIAL

20 SUBSTANCE USE DISORDER FACILITIES.— 

21 ‘‘(1) DEVELOPMENT OF SYSTEM.—The Sec22 retary shall develop a per diem prospective payment 

23 system for low-intensity clinically managed, high-in24 tensity clinically managed, and medically managed 

25 residential substance use disorder services, as those 


ssavage on LAPJG3WLY3PROD with BILLS
23 

•HR 9232 IH

1 terms are defined, respectively, in sections 

2 1861(nnn)(1), (ooo)(1), and 1861(ppp)(1) (collec3 tively, ‘residential substance use disorder services’). 

4 Such system shall include appropriate adjustments 

5 to reflect the differing resource-intensity of low-in6 tensity clinically managed, high-intensity clinically 

7 managed, and medically managed residential sub8 stance use disorder services, and may include an 

9 adequate patient classification system that reflects 

10 differences in patient resource use and cost. In de11 veloping such system, the Secretary may require 

12 clinically managed and medically managed residen13 tial substance use disorder facilities, as those terms 

14 are defined in sections 1861(nnn)(3) and (ppp)(3), 

15 respectively (collectively, ‘residential substance use 

16 disorder facilities’), to submit such information to 

17 the Secretary, including cost reports, as the Sec18 retary may require to develop such system. 

19 ‘‘(2) IMPLEMENTATION.— 

20 ‘‘(A) IN GENERAL.—The Secretary shall 

21 provide, for cost reporting periods beginning on 

22 or after October 1, 2025, for payments for resi23 dential substance use disorder services fur24 nished by residential substance use disorder fa25 cilities in accordance with the prospective payVerDate Sep 11 2014 18:29 Aug 30, 2024 Jkt 049200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H9232.IH H9232

ssavage on LAPJG3WLY3PROD with BILLS
24 

•HR 9232 IH

1 ment system established by the Secretary under 

2 this subsection. 

3 ‘‘(B) PAYMENTS.— 

4 ‘‘(i) INITIAL PAYMENTS.—The Sec5 retary shall implement such prospective 

6 payment system in the initial fiscal year so 

7 that the estimated aggregate amount of 

8 prospective payment rates is equal to 100 

9 percent of the estimated amount of reason10 able costs incurred by residential substance 

11 use disorder facilities in furnishing such 

12 services. 

13 ‘‘(ii) PAYMENTS IN SUBSEQUENT

14 YEARS.—Payments rates in years after the 

15 year of implementation of such system 

16 shall be the payment rates in the previous 

17 year, adjusted by an increase factor. Such 

18 factor shall be based on an appropriate 

19 percentage increase in a market basket of 

20 goods and services comprising the services 

21 for which payment is made under this sub22 section.’’. 

Æ 


ssavage on LAPJG3WLY3PROD with BILLS